Lactate and base excess as predictors of mortality in patients with Tetralogy of Fallot

Abstract

Objective To explore the distribution of lactate and base excess in children with Tetralogy of Fallot in perioperative period, its dynamic variation and its relationship with prognosis. Methods Perioperative arterial lactate level was dynamically monitored in 1 552 children with tetralogy of Fallot. According to the prognosis, 1 505 subjects were assigned to survive group, and 47 subjects to nonsurvive group. The lactate and base excess levels of all subjects were collected after induction(T1), after protamine administration(T2), and 24 h(T3) after surgery in the intensive care unit(ICU). Results The patients who could not survive showed significant elevated lactate levels as compared to patients who survived after surgery[(7.91±5.76)mmol/L vs.(1.20±0.51)mmol/L, P<0.05]. However, in nonsurvivors, the BE value decreased significantly in the ICU period in comparison to survivors[(-1.91±5.09)mmol/L vs.(2.52±2.85)mmol/L, P<0.05]. Logistic regression analysis was performed, indicating the elevated lactate and depressed base excess levels measured 24 h after surgery were independent risk factors. Conclusion The dynamic monitoring of lactate and base excess levels in the perioperative period in patients with tetralogy of Fallot were sensitive indicators to assess severity, to guide treatments, and for the prognosis. In the perioperative period, when the lactate increased and(or) base excess levels decreased, the mortality rate increased as well. lactate and base excess levels measured 24 h after surgery in the ICU were independent risk factors that significantly increased the mortality rate. Key words: Lactate; Base excess; Tetralogy of Fallot; Prognosis